Provider Demographics
NPI:1790815793
Name:GALLAGHER, CHARLOTTE EILEEN (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:EILEEN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55348 148TH ST
Mailing Address - Street 2:
Mailing Address - City:GOOD THUNDER
Mailing Address - State:MN
Mailing Address - Zip Code:56037-2168
Mailing Address - Country:US
Mailing Address - Phone:507-278-3884
Mailing Address - Fax:507-278-4690
Practice Address - Street 1:1008 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2405
Practice Address - Country:US
Practice Address - Phone:507-386-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist